{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T03:27:30Z","timestamp":1772854050904,"version":"3.50.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Non-severe hypoglycemia (NS-H) is challenging for people living with type 1 diabetes (PWT1D) and often results from relative iatrogenic hyper-insulinemia. Current guidelines recommend a one-size-fits-all approach of 15\u201320 g of simple carbohydrates (CHO) every 15\u00a0min regardless of the triggering conditions of the NS-H event. We aimed to test different amounts of CHO to treat insulin-induced NS-H at various glucose ranges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a randomized, four-way, crossover study involving PWT1D, testing NS-H treatment outcomes with 16\u00a0g vs. 32\u00a0g CHO at two plasma glucose (PG) ranges: A: 3.0\u20133.5 mmol\/L and B: &amp;lt;3.0 mmol\/L. Across all study arms, participants consumed an additional 16\u00a0g of CHO if PG was still &amp;lt;3.0 mmol\/L at 15\u00a0min and &amp;lt;4.0 mmol\/L at 45\u00a0min post-initial treatment. Subcutaneous insulin was used in a fasting state to induce NS-H. Participants had frequent venous sampling of PG, insulin, and glucagon levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants (<jats:italic>n<\/jats:italic> = 32; 56% female participants) had a mean (SD) age of 46.1 (17.1) years, had HbA1c at 54.0 (6.8 mmol\/mol) [7.1% (0.9%)], and had a diabetes duration of 27.5 (17.0) years; 56% were insulin pump users. We compared NS-H correction parameters between 16\u00a0g and 32\u00a0g of CHO for range A, 3.0\u20133.5 mmol\/L (<jats:italic>n<\/jats:italic> = 32), and range B, &amp;lt;3.0 mmol\/L (<jats:italic>n<\/jats:italic> = 29). Change in PG at 15\u00a0min for A: 0.1 (0.8) mmol\/L vs. 0.6 (0.9) mmol\/L, <jats:italic>p<\/jats:italic> = 0.02; and for B: 0.8 (0.9) mmol\/L vs. 0.8 (1.0) mmol\/L, <jats:italic>p<\/jats:italic> = 1.0. Percentage of participants with corrected episodes at 15\u00a0min: (A) 19% vs. 47%, <jats:italic>p<\/jats:italic> = 0.09; (B) 21% vs. 24%, <jats:italic>p<\/jats:italic> = 1.0.\u00a0A second treatment was necessary in (A) 50% vs. 15% of participants, <jats:italic>p<\/jats:italic> = 0.001; (B) 45% vs. 34% of participants, <jats:italic>p<\/jats:italic> = 0.37. No statistically significant differences in insulin and glucagon parameters were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NS-H, in the context of hyper-insulinemia, is difficult to treat in PWT1D. Initial consumption of 32\u00a0g of CHO revealed some advantages at the 3.0\u20133.5 mmol\/L range. This was not reproduced at lower PG ranges since participants needed additional CHO regardless of the amount of initial consumption.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:uri>ClinicalTrials.gov<\/jats:uri>, identifier NCT03489967.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1186680","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T13:17:27Z","timestamp":1685711847000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Non-severe hypoglycemia in type 1 diabetes: a randomized crossover trial comparing two quantities of oral carbohydrates at different insulin-induced hypoglycemia 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